The objective of this project is to implement and evaluate a nursing practice model to assist older, rural women in managing severe urinary incontinence (UI) while living at home. The nursing practice model is designed to structure the efforts of a nurse, an older, and a primary caregiver (where applicable) to establish measurable goals for continence and to develop a plan for managing UI that is sensitive to both the individual needs of the older and the sociocultural environment within which she resides. The specific aims are to: (1) describe and evaluate processes and outcomes associated with a nursing practice model - behavioral management for continence (BMC) - that includes specific techniques for managing UI; (2) evaluate the impact of model-specific factors as well as individual and social context characteristics on the attainment of behavioral goals; (3) evaluate the impact of the BMC intervention, individual, and social context characteristics on urine loss comparing treatment and control groups; and (4) conduct a cost-effectiveness analysis comparing BMC to formal community based and institutional services. The quasi-experimental design includes random assignment to treatment and control groups, repeated measures over time, and the use of both survey and clinical data. The sample will consist of 320 women 65 years of age or older who live in a nine county rural area in north-central Florida and experience severe stress, urge, or mixed UI. The principal outcome measure will be change in UI; however, additional bladder control variables, process measures, individual and social context characteristics, and cost-effectiveness data also will be analyzed. The significance of the project lies in: (a) delineating a nursing practice model (BMC) to enhance continence in a vulnerable, rural population; (b) obtaining a better understanding of factors that impact the attainment of continence goals; (c) evaluating the impact of BMC on UI for elders living at home; and (d) assessing the cost of BMC versus other community based and institutional alternatives.